I am currently pregnant and have had mental health support for anxiety. This was something I actively sort out but this has not been without concern.
So far my experience has been a positive one, but having read a lot of threads on MN about similar situations, this does not seem to be the case everywhere and support does not seem to be universally available.
I do not like the fact that this seems to be focused solely on depression. Anxiety can be strongly related to depression but is fundamentally different. It needs to be treated differently as a result, but it is very easy to suffer from both or for one to be mistaken for the other.
At my booking in appointment, I had a test to identify depression, however because I don't suffer from depression, I passed and didn't get flagged as being at potential risk of postnatal depression. However, I do know that my anxiety does put me at higher risk.
My biggest issue with the proposals is, if you bring in, this kind of discussion into general healthcare, separate from pregnancy in this way, I do think you run the risk of alienating women from HCPs rather than actively helping them. It could stop women from getting help they need as a result.
It really depends on the bedside manner of doctors and how they interpret the guidelines. Everyone knows that some are far better than others and sensitivity and tact is a skill not everyone possesses.
There is a real fear from depressed or anxious people that they will be judged for their illness and suggesting in someway that you will be 'a bad mother' needs to be handled with extreme care. Even if a woman was getting help for depression or anxiety they then could make try and avoid seeing HCPs to discuss pregnancy or if they fall pregnant.
Also there is a real fear by some that, they will be put on some sort of watch list by social services or could have their children taken away from them if they are depressed/anxious after the birth. I don't believe this is true (and indeed when I have raised this fear, I have been told that because I have sought help this is very much in my favour and suggests I am not a risk)
Put simply, I worry that in many cases this approach will only serve to feed fears and put additional unnecessary pressure on women who find themselves struggling to cope.
I think there instead needs to be promotion of mental health services in pregnancy or for those seeking to become pregnant, with the emphasis on women to seek help on their own terms rather than feeling like they are being forced down a particular route. One of the problems I personally had, was being able to access appropriate support with a midwife prior to getting pregnant as I had no previous children. My doctor was unsure what to do with me, as there was no care pathway for women in my position. The only real solution at the moment is to do a more general referral rather than one that focuses on having pregnancy/childbirth and subsequent period afterward. Something that is not always appropriate.
On top of that, I feel that pre-emptive treatment, also misses where the real need currently exists. I've seen a lot of posts on MN from women, who feel dismissed for raising their anxiety or depression by midwifes. There is a real lack of understanding within maternity services where problems come to a head. Its all very well advising women prior to pregnancy if those treating you during pregnancy are badly trained and ill equipped to deal with those problems. All to often women feel that poor treatment or attitudes may have contributed to their post-natal depression.
This also comes back to lack of services. I know that the mental health services at the hospital I am at, which I consider to be better than most places, are extremely strained and under pressure. Despite that, I know I am lucky. I also know that many areas have no peri-natal mental health support at all.
Currently the emphasis is on post-natal depression. This means the whole system is set up in a way which doesn't allow women to be in a position where they are supported earlier.